Management of obstructive renal failure caused by bilateral renal aspergilloma in an immunocompetent newborn

Area of Science:

• Pediatric Nephrology
• Mycology
• Infectious Diseases

Background:

• Fungal kidney infections are rare, typically affecting premature infants or immunocompromised adults.
• Candida species are the most common causative agents of fungal nephritis.
• This report focuses on an unusual case in an otherwise healthy newborn.

Purpose of the Study:

• To report a unique case of bilateral renal aspergilloma in an immunocompetent neonate with bladder exstrophy.
• To discuss the management strategies for this rare condition, including antifungal therapy and surgical intervention.
• To highlight the challenges in treating fungal renal infections in neonates with congenital anomalies.

Main Methods:

• Case report of a newborn with acute renal failure due to Aspergillus flavus infection.
• Treatment included bilateral nephrostomy with amphotericin B irrigation, systemic liposomal amphotericin B, and voriconazole.
• Long-term antifungal therapy and ureterostomies were required due to persistent colonization and obstruction.

Main Results:

• The newborn experienced improved renal function after initial treatment.
• Persistent fungal colonization necessitated prolonged antifungal treatment.
• Surgical management (ureterostomies) was required to address recurrent ureterorenal obstruction.
• Renal function was preserved as of November 2009, despite renal injury.

Conclusions:

• Bilateral renal aspergilloma is a rare but serious complication that can occur even in immunocompetent neonates with congenital anomalies.
• A multimodal treatment approach combining antifungal agents and surgical management of obstruction is crucial.
• Long-term follow-up is essential to monitor renal function and manage potential complications.